[Interest of an iterative specialized rehabilitation after an anterior cruciate ligament reconstruction in high level sport athletes].
OBJECTIVE
The aim of this work was to assess the usefulness of specialized rehabilitation sessions after anterior cruciate ligament reconstruction in high-level athletes participating in regional-, national-, or international-level sports.


METHODS
We conducted a retrospective comparison between two populations: in the first, rehabilitation was limited to the early postoperative period (PO); in the second, rehabilitation sessions were repeated, once in the early postoperative period and again 90 days later (POR). The second rehabilitation period lasted two or three weeks and included an open and closed-chain muscle training program controlled by physical therapists using isokinetic devices. The sessions also included proprioceptive exercises and cardiovascular exercise reconditioning with a therapeutic project developed by the Physical Medicine and Rehabilitation physician in collaboration with other health professionals and taking into consideration the surgical recommendations and the patient's clinical status. A questionnaire was addressed to all patients one year after the operation. The response rate was 55 %. Two groups were created at random: 74 patients were in the PO group and 75 in the POR group. The two populations were comparable in terms of gender (64 men, 10 women in PO versus 57 men and 18 women in POR), sports level (regional, national, international), type of surgery (41 hamsting, 33 bone-patellar tendon-bone in PO and 43 hamstring and 32 bone-patellar tendon-bone in POR) and sports (generally rugby, soccer, handball or ski).


RESULTS
Our results were statistically in favor of the group POR in terms of resumption of sports activities: time to return to training (7.6 versus 8.7 months, p=0.03) and time to return to competition (9.06 versus 10.84 months, p=0.007). They were also in favor of the group POR for resumption of sports activities at the former level (52.05 % versus 19.44 %, p=0.001), pain (numerical scale: 1.52 versus 2.03, p=0.021) and subjective impression (IKDC subjective score: 87.58 % versus 81.64 %, p=0.003). There was no significant difference for resumption of training (90.50 % versus 81.69 %, p=0.2) or competition (71.80 % versus 56.76 %, p=0.1) at one year, but the results were close to the level of significance.


CONCLUSIONS
Adapted preparation before returning to sports activities using a scheme elaborated by specialists (physicians, physical therapists, trainers) provided a statistically significant improvement in time and quality of resumed activity (return to prior level, pain, subjective IKDC score) in this specific population of high-level competition athletes. A larger series would be interesting to check the statistical significance of return to training and competition at one year. Another follow-up beyond one year (1.5 or two years for example) would also provide information on the percentage of definitive return to sports in these two populations.
Laboute
E
E
C.E.R.S., avenue Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France. e.laboute@gsante.fr
Savalli
L
L
Lefesvre
T
T
Puig
P
P
Trouve
P
P
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000534:rehabilitation* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012046:Rehabilitation / Q000379:methods; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors